Áine Aventin

The onus for educating and supporting young people in navigating romantic relationships often falls on professional youth work organizations; yet, evidence relating to healthy young adult relationship (HYAR) education programmes delivered within these settings remains limited. The present study sought to capture youth work professionals' views as part of a research programme focused on developing HYAR education resources for young people. Eleven youth work professionals in Northern Ireland participated in individual interviews or focus groups (5 interviews and 2 focus groups) between September and November 2024. Three master themes were identified using Reflexive Thematic Analysis: (1) defining and understanding coercive control; (2) barriers to communicating and reporting; and 3) training needs. The findings highlight professionals' perceptions of HYAR education and training needs of young people, parents and professionals. Participating professionals believed that youth work organizations should assume a key role in delivering HYAR education in a meaningful and accessible way.

Aim: To explore healthcare professionals’ confidence, skills and organisational support needs in providing pregnancy loss care within gynaecological settings in Northern Ireland. Design: This is a mixed‐methods, exploratory study. Methods: An anonymous online survey was completed by 18 healthcare professionals. Quantitative data were collected using the Perinatal Bereavement Care Confidence Scale and analysed with descriptive statistics. Open‐ended responses were analysed through qualitative content analysis. Results: The majority (83%) of participants acknowledged that pregnancy loss is a traumatic event for women. However, only 11% of participants felt well prepared to provide bereavement support. Organisational and environmental barriers were perceived to impede compassionate practice, and the majority of participants (94%) believed continuing bereavement education is needed. Grief counselling skills were highlighted as a particular training need. Analysis of the qualitative data generated four overarching categories reflecting healthcare professionals’ perspectives on pregnancy loss care within gynaecological settings: (1) creating safe and compassionate spaces, (2) systemic and structural pressures undermine care, (3) the need for skilled, confident and supported staff and (4) building organisational commitment to bereavement care. Conclusion: Healthcare professionals aspire to deliver dignified, person‐centred care following pregnancy loss but face systematic and educational barriers. Increasing organisational support as well as investment in staffing levels, bereavement training and access to emotional support are essential for the provision and sustainability of high‐quality bereavement care and staff wellbeing. Implications for the Profession: Embedding bereavement education, reflective practice and dedicated bereavement care environments within gynaecological services could foster confidence and consistency of bereavement care for pregnancy loss in this setting. Patient or Public Contribution: An advisory group comprising clinicians, bereavement support organisations and women with lived experience contributed to this study. Reporting Method: This study adheres to the GRAMMS checklist for mixed‐methods reporting.

As many as 15.3% of pregnancies do not end in a live birth meaning miscarriage is among the most common pregnancy complications. This experience is robustly evidenced to be associated with adverse health and well-being outcomes for mothers, however, much existing evidence focuses on psychopathology outcomes such as depression and anxiety disorders. Adopting a holistic approach inclusive of more nuanced mental health outcomes of pregnancy loss, this study sought to assess and compare distress among women experiencing miscarriage at home or in hospital. The current study applied Network Analysis to examine associations between indicators of psychological distress (e.g. feelings of loss, isolation, and devastation) in a sample of 839 women. Networks were assessed to identify the most influential indicators for the total sample of women who experienced miscarriage in the previous 5 years (N = 839), and for subsamples who reported experiencing management of their miscarriage at home (n = 493), or in hospital (n = 273). Results highlighted the most influential distress indicators in the network to be: 'feelings of a person lost', 'destroyed zest for life', and 'feelings of isolation'. Comparison between subgroups, those who experienced miscarriage at home and in hospital, revealed similar network structures. Those who experienced miscarriage at home displayed greater global association between nodes in the network, i.e. stronger connections between distress indicators suggesting these have greater influence on each other a potentially exacerbate distress. The most influential distress indicators are highlighted as important targets for screening psychological distress, and as potentially viable intervention targets to promote greater well-being among women experiencing miscarriage, regardless of setting. These findings provide a novel understanding of psychological distress following miscarriage as a system of connected symptoms, further research is called for to examine broader influences of the impact of miscarriage network.

Background: Research suggests multiple experiences of miscarriage, also known as recurrent pregnancy loss (RPL), may be associated with compounded risk for adverse mental health impacts. However, there is a need for research evidence that offers clarity in relation to potential predictors of psychological distress and wellbeing among this neglected population of women. This paper aims to explore physical and experiential factors associated with miscarriage-related psychological distress and wellbeing among women who had experienced RPL. Methods: Adopting a mixed methods approach, the paper presents a secondary analysis of data which assessed the perceived impact of miscarriage experience as measured by the Revised Impact of Miscarriage Scale (RIMS) in a cross-sectional survey of ( n = 839) women in Northern Ireland and thematic analysis of qualitative interviews with a sub-sample of the women ( n = 10) who experienced RPL. Results: Quantitative analysis indicated that women who experienced two or more losses reported significantly greater miscarriage-related distress when compared with those who experienced one miscarriage. This was true for the ‘Devastating Event’ and ‘Loss of Baby’ RIMS subscales, however, differences between groups related to ‘Isolation and Guilt’ were non-significant. Qualitative analysis identified themes consistent with the RIMS. These included potential predictors of distress such as devastating memories, anticipated loss and disenfranchised grief, as well as feelings of isolation and guilt stemming from social stigma and inadequate support. Conclusion: The experience of RPL is extremely distressing, with the potential to lead to maternal morbidity. To support women’s reproductive health and rights, compassionate healthcare that includes mental health and memory-making support are important during miscarriage and subsequent pregnancies.

The consistently high prevalence of unwanted sexual experiences (USEs) on university campuses has led to increasing calls for evidence-based solutions to inform policies, training, and intervention development. However, Research Ethics Committees are often hesitant to approve sexual trauma research due to beliefs that asking participants about traumatic experiences will cause extreme distress. Conversely, previous literature has found that many participants who have experienced sexual trauma report positive reactions following their participation in such research. Studies have found that while immediate negative emotional reactions are common, this distress is short-term (e.g., lasting only minutes or hours after participation). The present study assessed 469 Northern Irish university students’ experiences of participating in research addressing USEs. The findings indicated that participating in USE research was a positive experience for participants, regardless of victimization status. Further, participants who reported a victimization experience did not report experiencing a negative emotional reaction to participating in the study. This article considers the ethics of conducting sexual trauma research among university students, with reference to common ethical concerns that can be addressed as part of the research process.

Objective: The aim of this study was to explore parents' experiences of their relationships and interactions with healthcare professionals (HCPs) during care related to prenatal diagnosis and termination of pregnancy for foetal anomaly (TOPFA).Methods: A qualitative approach was used. Participants included 33 parents (23 women and 10 men) from Northern Ireland (n = 11) and Ireland (n = 22) who had a TOPFA. Data collection methods included semi‐structured interviews and written narrative accounts. Data were analysed using thematic analysis.Results: Findings confirmed that TOPFA was a traumatic, life‐altering experience for parents, impacting their health and well‐being. The actions, behaviours and words of HCPs impacted how parents perceived and interpreted their healthcare experiences and their access to services and supports. In relation to this, five themes are presented: (1) the importance of compassionate and non‐judgemental care, (2) the value of effective information and communication, (3) the desire for compassionate care for baby and facilitation of memory making, (4) the need for continuity of care and (5) parents' experiences of healthcare relationships during times of legislative change.Conclusion: This research reveals the important role HCPs play in helping parents cope with prenatal testing and TOPFA. Parents who had a positive relationship with an HCP, in which information was communicated effectively and compassionate and non‐judgmental care was provided, felt more supported and more able to accept and adapt to their loss.Patient and Public Contribution: An advisory group composed of parents who had experienced TOPFA and HCPs with experience in caring for such families were involved in the study from the outset, contributing to the design and development of data collection materials, interpretation of the findings and design of dissemination materials.

Background: The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives: To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design: A cluster randomised trial, incorporating health economics and process evaluations. Setting: Sixty-six schools across the four nations of the UK. Participants: Students aged 13–14 years. Intervention: A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures: Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12–14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results: The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI –£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI –£15.60 to –£3.83). Limitations: The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions: We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12–14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work: Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration: This trial is registered as ISRCTN10751359. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.

Background: Research highlights the importance of compassionate communication, adequate delivery of information, and professional support to help alleviate parental distress following pregnancy loss. However, many healthcare professionals do not feel sufficiently trained to deal with pregnancy loss in practice. We aimed to address this deficiency with an evidence-informed educational intervention to increase knowledge, skills, self-awareness, and confidence regarding pregnancy loss among UK nursing students. Methods: Educational resources, which included an 82-minute podcast and 40-minute online lecture were developed. The podcast focused on the lived experiences of three women who had experienced miscarriage, stillbirth, and termination of pregnancy for medical reasons. The pre-recorded lecture included definitions of types of pregnancy loss, discussion of the importance of communication, and information on the clinical management of pregnancy loss. Students were presented with both the lecture and podcast as a self-directed element of existing curricula. A pre-test/post-test cross-sectional survey design was used to investigate the impact of the educational intervention. The Perinatal Bereavement Care Confidence Scale (PBCCS) was completed by 244 first year BSc Nursing students before and up to a week after receiving the intervention. Quantitative data were analysed using a Paired Samples Wilcoxon test. Responses to open-ended questions, which allowed students to give feedback on the intervention content and delivery were analysed using Qualitative Content Analysis. Results: 96% (n = 235) of the sample reported having no prior experience or training in the management and support of those experiencing pregnancy loss. At pre-test, 88% (n = 215) of students rated themselves as not confident in dealing with pregnancy loss in a professional capacity. Post-test, we found statistically significant effects for perceived competency on all learning outcomes (p < .001). Qualitative analysis of n = 745 individual text responses to open-ended questions indicated four categories related to the perceived value of using real-life stories for learning, demystifying a taboo subject, and providing tools for practice. Respondents suggested the inclusion of more information on memory-making, support networks, and mental health following pregnancy loss. Conclusions: The educational intervention increased student nurses’ perceived knowledge, confidence, and skills in caring for families experiencing pregnancy loss. This offers potential for increased quality of care for those experiencing pregnancy loss in healthcare settings, increased patient satisfaction, and improved mental health-related outcomes.

Background: Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group. Methods: This review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a ‘best-fit’ framework synthesis approach. Results: We coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors. Conclusion: SRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. Given the existence of multilevel barriers and facilitators, interventions should, likewise, take a multilevel approach that incorporates locally relevant understanding of the individual-, interpersonal- and structural-level barriers and facilitators to condom use among adolescents in the region.